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Diuretics and Statins Are Associated with New-Onset Diabetes

January 14, 2014

Diuretics and Statins Are Associated with New-Onset Diabetes

  1. Paul S. Mueller, MD, MPH, FACP

These drugs — but not β-blockers or calcium-channel blockers — were associated with new-onset diabetes in patients with impaired glucose tolerance.

  1. Paul S. Mueller, MD, MPH, FACP

Evidence suggests that β-blocker, diuretic, or statin use increases risk for new-onset diabetes. In this reanalysis of the randomized, controlled NAVIGATOR trial (NEJM JW Cardiol Mar 14 2010) data, investigators assessed whether β-blocker, thiazide diuretic, statin, or calcium-channel blocker (CCB) use in >9300 patients with impaired glucose tolerance and cardiovascular risk factors was associated with new-onset diabetes.

During a median follow-up of 5 years, β-blockers, thiazide diuretics, statins, and CCBs were each started in about 20% of patients who had not been exposed to these drugs previously. After adjustment for multiple variables, risk for new-onset diabetes was significantly higher in patients who initiated diuretics (hazard ratio, 1.2) or statins (HR, 1.5) than in patients who were not treated with diuretics or statins, respectively. The number needed to harm for diuretics was 17 and for statins was 12. Risk for new-onset diabetes did not change among patients who initiated β-blockers or CCBs.

Comment

In this study, thiazide diuretics and statins, but not β-blockers and calcium-channel blockers, were associated with excess risk for new-onset diabetes in patients with impaired glucose tolerance and cardiovascular risk factors. The authors recommend that glycemia be monitored when these drugs are initiated in patients at high risk. Although confounding is possible given the study's design, other studies have linked statin use (NEJM JW Gen Med Jul 19 2011) and diuretic and β-blocker use (NEJM JW Gen Med May 30 2006) with new-onset diabetes. Nonetheless, the benefits of these drugs probably outweigh this risk in selected patients.

  • Disclosures for Paul S. Mueller, MD, MPH, FACP at time of publication Consultant / advisory board Boston Scientific (Patient Safety Advisory Board) Leadership positions in professional societies American Osler Society (Secretary)

Citation(s):

Reader Comments (12)

sharat samantray Physician, Endocrinology, Amri hospitals, Bhubaneswar, Odisha, India

Statins are invaluable for treatment of dyslipidaemia & CHD prevention. We know potent statins do worsen gl tolerance but benefit outweighs risk.Similarly thaiazide, a time tested anti-hypertensive at low dose does not cause significant gl intolerance.Hypertension is a known risk factor for diabetes. Hence inference drawn from the study be taken as a pinch of salt.

Takeshi Yamada Physician, Surgery, Specialized, Koga red cross hospita in Japanl

informative article, thank you

dr.rajabpour Resident, Internal Medicine, babol health_ care center

but a question is unanswered, do any physician and dear colleagues have personal experiences for their patients about the effects of such drugs...?

Jeffrey Waggoner, MD Physician, Family Medicine/General Practice, Rural clinic

The Veteran's Study, the first large scale study of treatment of hypertension, was initially interpreted as showing diuretics had "no beneficial effect "...indeed, they seemed to be associated with premature death. Then, a second interpretation of the data concluded, "Never mind. Our bad. Diuretics are terrific!" This was 40 years ago! SOMEBODY NEEDS TO GET THESE GUYS REAL JOBS SO THEY STOP CONFUSING THE REST OF US WITH THEIR EVER-CHANGING BALONEY.

OFEIGUR T THORGEIRSSON Physician, Family Medicine/General Practice

Sometimes, I really wonder about all this flow of information on the value of various treatments, or possible harm. I am diagnosing people on a regular basis with "pre-diabetic" condition: Overweight individuals with hypertension, dyslipidemia and borderline A1c. My approach so far is to recommend low to medium dose statins. What am I to do now? Is this a harmful approach, as implied by this study? Also, beta-blockers are now metabolically ok according to this study, but still harmful in the elderly as treatment for hypertension according to meta-analysis by Messerli and collegues! All these counfounding meta-analysis are not helping me practicing medicine.

R. Ed Myer, MD Physician, Family Medicine/General Practice, SeaMar Community Health Clinics, Seattle

Statins stressing our ligaments and tendons, and now predisposing (RR 1.5!!!) to Diabetes.....right when guidelines are being published suggesting MORE people should be on statins......Oh dear!

MIKE O'CONNOR Other, retired academic hr

article does not state the strength of statins used in the test so those on the minimum dose need not worry.can not believe that eggs are anything but good for you,after 73 years I enjoy them several days a week.

Benito Minzer; MD Physician, Cardiology, Office

I agree with the last phrase of the coment. It´s a long time I´m prescribing thiazide diuretics, beta blockers, statins and CCB.
And I´m always taking care and control of my patients.

Dr. V Kantariya MD Physician, Family Medicine/General Practice

"Diuretics and Statins Are Associated with New-Onset Diabetes"! But Diuretics and Statins are not the same, they are different. Atorvastatin, Rosuvastatin, and Simvastatin are associated with Excess Risk for Diabetes, Fluvastatin, Lovastatin are not associated with excess risk. Make the Right Choice!

Dr Debasish Sarma Roy Physician, Other

Long ago some British MPs argued to introduce statins in the public drinking water system for their alleged benefits. Is there any chance of booking them for possible kick-backs from the pharmas, or is it only the med practitioners who will be nailed always for such things?

PHIL GOLD Physician, Allergy/Immunology, Montreal, Canada

Well done.

PHIL GOLD Physician, Allergy/Immunology, Montreal, Canada

Well done.

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